Healthy City Capacity Mapping:
Resilient Management in the Aftermath of the COVID-19 Pandemic Case Studies of Yogyakarta City, Indonesia and Marikina City, the Philippines
Indah Cahyaning Sari1, Annisaa Indrarini1, Aarth Hutabarat1, Saut Sagala2,
Shafiyah Fakhrona 3, Danang Azhari1, Ebinezer R. Florano4, Rose Gay Castaneda5

1 Research Officer, Resilience Development Initiative, Indonesia
2 Associate Professor, Bandung Institute of Technology, Indonesia
3 Research Assistant, Institute of Research and Community Services, University of Brawijaya, Indonesia
4 Professor, National College of Public Administration and Governance, University of the Philippines, Philippines
5 Researcher, National College of Public Administration and Governance, University of the Philippines, Philippines

COVID-19のパンデミックに東南アジアの諸都市はいかに立ち向かったか。本稿ではジョグジャカルタ（インドネシア）、マリ
キナ（フィリピン）の両市における実践例を検証し、公衆衛生面のレジリエンス管理の諸課題を探った。

Abstract

Cities are facing the complexities of urban challenges, particularly with the COVID-19 pandemic, in which cities
across the globe need to adapt in terms of health management not only to recover from the pandemic situation but
also to build resilience and preparedness for the possibility of future public health crises. Related to this, Indonesia
and the Philippines are countries that initiated the Healthy City project in Yogyakarta City and Marikina City, respectively. In Indonesia, Yogyakarta City won the highest award, i.e., Swasti Saba Wistara, seven times in a row for
Healthy City implementation. Meanwhile, in the Philippines, Marikina City was cited by the World Health Organization
as one of Asia's healthiest cities. This study aims to discuss Healthy City implementation in the two cities. The six
dimensions of Healthy City capacity mapping were used as determinants in this study, which are: (1) demographic
and geographic profile, (2) policies and regulations, (3) governance and organizational structure, (4) participatory
planning and budgeting, (5) urban facilities and infrastructure, and (6) urban environment. Data collection of thiscomparative study involved desk review and spatial observation through optimization of GIS technology. Mixed
methods of qualitative and quantitative analysis were employed for data processing and analysis. The study's implication is expected to be evidence-based on healthy city program implementation, which could be widely adaptedboth non- and physically in urban built environments. Furthermore, the lesson learned also could be used as strategies of resilient management incorporating urban health elements in facing the COVID-19 pandemic.
Keywords

Resilience, Healthy City, COVID-19, urban planning, urban built environment

Introduction

Rapid city growth affects various aspects, not justlimited to physical problems such as strained basic
infrastructure but also those related to the economy,society, culture, politics, and health. The COVID-19
pandemic has shown immense possibilities in worsening this urban living environment. Urban resilienceneeds to be leveraged to overcome these urban challenges, one of which is through adopting the Healthy
City approach. The concept of a Healthy City is continuously creating and improving physical and social environments to enable healthy living (Lee & Nakamura,2021). The World Health Organization (WHO) introduced this concept in 1980 as a comprehensive approach
aimed at facilitating and creating a healthier urban environment (Fitry et al., 2020). In short, the Healthy City
approach is a holistic perspective that seeks to improvephysical, environmental, economic, and social developments in urban areas. Many countries have been implementing this approach, including Indonesia and thePhilippines.
Despite its capability to assess needs and improve
Healthy City development, Healthy City capacity mapping is rarely undertaken (Lowe et al., 2019). However,191

Indah Cahyaning Sari, et al.

more evidence from low- and middle-income countries
on how urban planning contributes to public health isstill needed, especially in the post-COVID-19 landscape(Luo et al., 2022). In Indonesia, Healthy City has been
implemented since the early 2000s through its incorporation in the Ministry of Health regulations and policies(Palutturi et al., 2015). One of the healthiest cities inIndonesia is Yogyakarta City which won the highest
award Swasti Saba Wistara for Healthy City implementation seven times in a row. As the impacts of the pandemic were felt, the Yogyakarta City Government andits communities responded well. Thus, the city has beenchosen as the site of the pilot project to bolster the
Healthy City concept, particularly in implementing
Kampung Tangguh Nusantara, Wellness Destination,and Healthy Family Program. In the Philippines,
Marikina City, a suburb of the capital city Manila, wascited by the WHO as one of Asia’s healthiest cities. The
city received recognition for promoting a healthy environment for children and for making the city safe
through emergency preparedness planning. The Healthy
City initiative in Marikina was implemented in the early
2000s that was dominantly infrastructure-driven andfocused on environmental and health concerns. Since
the creation of the Healthy Cities Management Task
Force, the city has embarked on various programs andprojects such as Dust-Free Marikina, Bicycle-Friendly
City, Healthy Tourist Park, Clean Food Laboratory,
Urban River Rehabilitation, Jogging Lanes, etc. (Yu &Sajor, 2008).
The two cities incorporated the Healthy City concept
into many of their policies with high levels of commitment from their governments. As a result, they wereawarded for their innovations in implementing the concept. This paper aims to probe the elements of urban
health in both cities using the six determinants of the
Urban Health Index (UHI) and identifying programs
and policies that promote Healthy City development.
This study is significant because it could serve as anevidence-based reference of Healthy City for other cities
to bolster resilience management for further development, alongside other specific problems such as the
COVID-19 pandemic.

192

Literature Review and Framework

To promote the good practice of Healthy City implementation, the WHO announced ten criteria for it in
1996, which required healthy cities to provide quality
environmental health, harmonious social health, andothers (Li, et al., 2020). In 2004, the WHO introduced
helpful tools to promote health through capacity mapping to help planners and decision-makers. According
to LaFond et al. (2002), mapping is the first step indesigning capacity-building interventions and providing a valuable framework to monitor and evaluate theeffectiveness of a program. Mapping urban health could
link planning inputs and health outcomes (Green et al.,2009). The measurement of urban dwellers’ health islinked to various characteristics and circumstances,
physical settings, living and working conditions, environment, quality of services, and community organization, among others (Hanzl & Bezzera, 2019). Many
researchers develop and generate indicators for Healthy
City. Webster and Sanderson (2012) developed one of
the recognized indicators, which provided sets of healthassessment factors. Another prominent measurementthat considers health within a given urban geographicalboundary is the WHO’s UHI. The UHI gives insights on
various health indicators to enable temporal and geographical comparisons. Depart from these fundamental
indicators, the six main umbrellas upon which indicators are based upon has been similarly used, which is a
succession of improvements on predecessor HCI, withthe detail determinants as follows:6th AFC Best Papers (2022)

classifications i.e., low, medium, and high categories,
where the highest observation value was derived fromthe highest national average value of indicators vis-à-vis
the lowest national average value of indicators which
was obtained from the lowest observation value. The
following is the formula:Fig. 1. Conceptual Framework of Healthy City Capacity
Mapping

Methodology

This research applies mixed methodology, i.e., qualitative, quantitative, and spatial analyses, in order toexplore and produce holistic depictions. These methods
were applied simultaneously to identify the elements ofa healthy city and their manifestations in resilience to beable to determine how the Healthy City concept could
be an alternative approach to addressing the impacts ofpandemics. The qualitative content analysis methodology was utilized to identify Healthy City initiatives’policies, programs, and activities in Yogyakarta andMarikina. Various documents, including existing regulations, planning documents, reports, or related studies
about Healthy City in Yogyakarta and Marikina, werereviewed to identify the integration and synergy throughthe lens of resilience.
Statistical techniques were employed to quantify andanalyze variables. Graphs and raw data tables were constructed to make it easier to analyze the results.
Quantitative analysis techniques were used to score andweigh the capacity of both cities based on the six determinants of UHI. Each determinant was measured by aspecific indicator shown in Table 1. The indicators index
was obtained from the UHI adopted by WHO (2018) andseveral scientific journals’ literature reviews. For indicators which has no standard, the index was determinedby Sturges formulation with three levels of

Spatial analysis was also carried out to extract information from the spatial data. This process includes
examining the locations and attributes of features in thespatial phenomenon performed using Arc GIS 10.5. The
spatial analysis of geospatial data is about spatial geometry’s statistical and structural characterization (Bishop& Giardino, 2021), which includes various types of spatial analysis such as overlay, raster, contiguity, surface,and linear analysis (Paramasivam & Venkatramanan,2019). This research adopted surface analysis to map
green open spaces in Yogyakarta and Marikina.

Results and Discussions

Healthy City: A Response to the COVID-19 Pandemic
As COVID-19 spread across the world, cities acted
as centers of its community transmission, as well as
entry points into the further country-wide transmission
through national and international travels and trades.
Some cities became national epicenters of the pandemic,
amplifying the spread and transmission of infection,
while also often serving as healthcare surge points.

Fig. 2. Pattern of Positive COVID-19 Confirmed Case in
Marikina
Source: Department of Health, Republic of the Philippines

193Indah Cahyaning Sari, et al.

Cities were very much affected by the COVID-19
pandemic during the years 2020-2021, including
Yogyakarta and Marikina. As of March 2022,
Yogyakarta and Marikina recorded 33.791, and 39.277
total confirmed pandemic cases, respectively. Urban
dwellers live in a higher concentration inside urban
perimeters, which expose them to contagious diseases,
like epidemiological outbreaks, that are prone to crowding (Hanzl & Bezerra, 2019). Health services played
major indispensable roles in this unprecedented situation. Health service is a fundamental factor for urban
health and typically includes hospitals and healthcare
centers (Luo et al., 2022). Health services and infrastructure availability in both cities have resulted in an
average of 96% of people affected who have recoveredfrom the disease, where 32.365 and 37.932 people recovered in Yogyakarta and Marikina, respectively.
Healthy City Capacity Mapping in Yogyakarta andMarikina
Demographic and Geographic Profiles
Demographic and geographic are essential in portraying urban structures. This baseline information could be
used in order to assess needs and improve healthy city
development (Palutturi, 2015). According to Sutcliffe etal. (2015), the health of urban populations is essential tobe regularly reported and monitored, even though, somehow, the data sets that link this concept are largely lacking, especially on a small scale. The general characteristicof the demographic and geographic profiles of Yogyakarta
and Marikina are shown in Table 1 below.
Yogyakarta is located in the central south of Java
Island, Indonesia, while Marikina is in the eastern partof Metro Manila, called the “Gateway to the East.”
Marikina is categorized as a highly urbanized city dominated by residential and industrial areas. Residential
and tourism areas also dominate Yogyakarta. In termsof demographic components pertaining to the healthstatus of city inhabitants, morbidity and mortality rate
are used as benchmarks in measuring urban health(Webster & Sanderson, 2012 & WHO, 2018). Bothcities’ morbidity and mortality rates show that
Yogyakarta performed better than Marikina in

194

Table 1. Demographic, and Geographic Profiles of
Yogyakarta and Marikina (2020)
Determinants
Yogyakarta
Geographic
Population density per
12,781square km
people/km2
Total area
32.50 km2
Number of sub-districts/
14 subbarangay
districts
Demographic (Health Status)
373,589
Urban population
people1
Population growth per year
-0.38%1
Infant mortality rate
11.223
Maternal mortality ratio
64.143Morbidity rate (by type of2703
disease – diarrhea)

Marikina
21,192
people/km2
21.52 km2
16 barangays(2 districts)
456,059
people2
0.73%219.774122.904
6134

Source: 1 Yogyakarta City in Figure Year 2021 by Central Bureau of
Statistics Yogyakarta City (BPS)
22020 Census Population and Housing Report by thePhilippine Statistics Authority (PSA)
3
Yogyakarta Health Profile Year 2021 by Yogyakarta City
Health Agency (DOH)
4
Field Health Services Information System Annual Report by
Department of Health Republic of the Philippines (DOH)

comparative national-level values. However, both cities
underperformed vis-a-vis their national averages.
Policies and Regulations
In implementing and developing programs, countries
and organizations must provide a policy framework that
explains the objective to be achieved and the means bywhich it will be achieved (Palutturi, 2015). Regarding
Healthy City implementation, the notion of Healthy City
was incorporated and embodied in Indonesia’s healthdevelopment policies in the early 2000s. Indonesia
already has its National Policy and Guideline that
explains the Healthy City application, classification, andcriteria, evaluation and award systems, capacity building, coordination, supervision, and budgeting, as well as
forms for Healthy City assessment. Even though
Yogyakarta has no special regulation addressing Healthy
City implementation directly, such as Healthy City laws
or guidelines, the implementation of Healthy City is
manifested in several sectoral regulations that promote
the establishment of a Healthy City. Below are some of
the regulations and city/sector plans that intersect with
the Healthy City concept, as shown in Table 2.

6th AFC Best Papers (2022)
Yogyakarta
Marikina
Indonesia Healthy
Program (2010)
Provincial/ HUC Level
1) Governor
Ordinance Number
44 Year 2017
regarding Regional
Action Plan of
Yogyakarta for
Sustainable and
Healthy Living
Movement
District/City/Local Level
1) Regional Ordinance 1) Ordinance Number 075
Number 11 Year
Series of 2019 regarding
2017 regarding
Nutrition (Bread) Program
Medium-Termfor Undernourished
Development
Plan
Kindergarten and Grade One
Fig. 3. Yogyakarta City Map in Indonesia (Left) and Marikina City Map
in The Philippines(Right)(RPJM) of
2) Ordinance Number 48 Series
Source: Indonesia Geospatial Portal & Database of Global Administrative Areas (GADM)
Yogyakarta Cityof 2010 regarding No
Year 2017-2022
Smoking Areas in Marikina
2) Regional OrdinanceCity
Number 2 Year3) Ordinance Number 035
Table 2. Existing Regulations Intersecting with Healthy
Marikina
2017Yogyakarta
regardingSeries of 2016
regarding Free
District/City/Local
City
Smoke-Free Area Level Medicine to Senior Citizens
Number 075
Regional
Ordinance 1)of Ordinance3) 1)Mayor
Ordinance
Marikina City
Yogyakarta
Marikina
NumberYear
Series ofNumber
2019 regarding
Number5011
Year4) Ordinance078
National Level
2017
regarding
Nutrition(Bread)Program2017
regardingSeriesof 2019,
regarding
1) Joint Regulation of
1) Republic of the Philippines,
Medium-Termfor Undernourished
Healthy
Livingofferingof medical
Department of Health (DOH)
Minister of Home
Kindergarten
andtoGrade One
Development Plan
MovementscholarshipgrantsAdministrative Order (AO)
Affairs and(RPJM)
of2)qualified
Ordinance
NumberSeries4) Mayor
Ordinance
residents
who48aspire
Number 2011-0008 about
Minister of Health
Yogyakarta
2010 regarding
Number
3 YearCity
to ofbecomea doctor No
Guidelines on Urban Health
Number 34 of 2005Year
2017-2022
SmokingNumber
Areas in15
Marikina
2016
regarding5) Ordinance
SeriesSystems Development
about guidelines for2)Resilient
Regional
Ordinance
Urban
of City
2016 regarding thethe implementation
Number 2 Year3)promotion
Ordinance
Number035
Villageanddevelopmentof Healthy Cities
2017 regarding
2016 regardingFree5) Regional
Ordinanceof Series
urban ofgardeningto2) Minister of Health
Smoke-Free
Area
Medicineto Senior foodCitizens
Number10 Yeardevelopa sustainable
Decree Numberof Marikina City3)2010Mayor
Ordinance
regarding
production
Marikina
574 Yogyakarta
of 2000
Number50 YearOrdinance
Number
HealthAssurance
6) 4)Ordinance
Number
63078
SeriesNational
Level
concerning
Health2017 regardingof 2019, regarding
Systemof Series
2003, requiring
all food
1)development
Joint Regulation of
1) Republic of the Philippines,
Healthy
Livingofferingof medical
6) Mayor
Ordinanceeateryownersand helpers in
Ministerof Home
Department of Health (DOH)
policies
especiallyscholarshiptoMovement
Number61 Yearpublicmarketsgrants
to undergoa
Yogyakarta
MarikinaOrder (AO)
AffairsandAdministrativeforsupporting
qualified residents
who aspire4)2013
Mayor
Ordinance
regardingcomprehensive
food safety
Indonesia
MinisterHealthyof HealthNumber 2011-0008 about
Number
3 Yearto becomea doctor
Healthy
Elderlypersonal
hygienetraining
ProgramNumber(2010)34 of 2005
Guidelines on Urban Health5) Ordinance Number 15 Series
2016 regarding
Provincial/
Levelforabout HUC
guidelines
Systems Developmentof 2016 regarding theResilient Urban
the implementation
1) Governor
promotion and development
Villageof Healthy
CitiesOrdinance
Numberof urban gardening to5) Regional Ordinance2)44Ministerof HealthYear 2017
develop a sustainable food
Number 10 Year
Decree Number
regarding
Regional
production2010 regarding
574 ofPlan
2000
Actionof6) Ordinance Number 63 Series
Health Assurance
concerningfor
HealthYogyakarta
of 2003, requiring all food
Systemdevelopment
Sustainable
andeatery owners and helpers in
6) Mayor Ordinancepolicies
especially
Healthy
Livingpublic markets to undergo a
Number 61 Yearfor supporting
Movement
comprehensive food safety
2013 regarding
District/City/Local Levelpersonal hygiene training
Healthy Elderly
1) Regional Ordinance 1) Ordinance Number 075
Care Center in
Number 11 Year
Series of 2019 regarding
Yogyakarta
2017 regarding
Nutrition (Bread) Program
Medium-Termfor Undernourished
Development Plan
Kindergarten and Grade One(RPJM) of
2) Ordinance Number 48 Series
Yogyakarta Cityof 2010 regarding No
195
Year 2017-2022
Smoking Areas in Marikina
2) Regional OrdinanceCity
Number 2 Year3) Ordinance Number 035
2017 regarding
Series of 2016 regarding Free
Smoke-Free Area
Medicine to Senior Citizens

Indah Cahyaning Sari, et al.

In regard to the Healthy City implementation, The
Philippines also has a guideline at the national level
about urban health systems development. In July 2011,
the Department of Health (DOH) issued Administrative
Order (AO) Number 2011-0008. Based on the AO, theDOH encourages the development of a healthier urban
environment as rapid urbanization in the Philippines
became unmanageable. The order created the Urban
Health System Development (UHSD) program, which
consists of three developmental components as follows:
1) Developmental programs for urban areas, including Healthy Cities Initiative (HCI), Reaching
Every Depressed Barangay (RED), andEnvironmentally Sustainable and Healthy Urban
Transport (ESHUT);
2) Planning tools and framework, which comprise of
Urban Health Equity Assessment and Response
Tool (Urban HEART), and City-wide Investment
Planning for Health (CIPH);
3) Capacity building through a short course on
Urban Health Equity (SCUHE).
Healthy City implementation at the regional andlocal levels in Metro Manila and Marikina is similar to
those in Indonesia, which does not have special regulations directly addressing it. However, the city governments of Yogyakarta and Marikina have many initiatives
in the form of regulations that intersect with Healthy
City implementation. The implementations are throughcity development and other sectoral plans that promote a
healthier urban environment.
Governance and Organizational Structure
The organizational level is an essential aspect of mapping health capacity (LaFond et al., 2002). This relates
to structures, processes, and management systems,
including personnel and resources, that improve organizational performance. Organizational form influences
mechanisms that are needed for implementation andwhat roles need to be played (Palutturi, 2015). Intersectoral participation is significant for establishing ahealthy city (Kenzer, 2000; O’Neil, 2006). Healthy Cityin Yogyakarta is handled and coordinated by the
Yogyakarta City Health Agency. In 2020, Yogyakarta

196

focused on ten settings/types of Healthy City, where
each setting is managed by a department (Table 3).
Table 3. Healthy City Settings or Type and Agency in
Charged for Yogyakarta City
Settings
Mandatory Settings- Healthy settlement
areas and public
facilities- Self-reliant
community, food andnutrition security- Market- Education
Additional Settings- Healthy community
life and disaster
resilience- Healthytransportation
services and traffic
regulation- Healthy
industry/homeindustry and officeareas- Tourism- Place of worship- Smart city

Agency in Charge- Housing and Settlement Area
Office- Health Office and Food Crop
Agriculture Office- Industry and Trade Office- Education Office- Social Office and Regional
Agency for Disaster
Management- Transportation Office- Industry and Trade Office,Cooperative and SmallMedium Enterprise Office, andManpower and Transmigration
Office- Tourism Office- Public Administration
Department- Communication, Informatics,
and Public Relations OfficeAccording to The National Guideline of Healthy
City, a technical working team and a citizen forum
should be formed to boost the implementation of the
Healthy City concept. Cities should endeavor to form atechnical working team as the representative of the government sector and a Healthy City forum as the representative of the citizens. According to an author,
effectively addressing challenges to urban healthrequires engagement from multiple actors at multiple
levels, including citizens (Stevens, et al., 2020). The
Yogyakarta City Government has involved various
stakeholders from non-governmental institutions tocooperate in generating more local-level results andwith community contributions at the urban village level(Figure 4).

6th AFC Best Papers (2022)

Fig. 5. Governance and Organizational Structure of
Healthy City Implementation in Marikina City
Source: Department of Health, Republic of the Philippines

Fig. 4. Governance and Organizational Structure of
Healthy City Implementation in Yogyakarta City
Source: Indonesian Ministry of HealthIn the Philippines, the UHSD Program was initiatedby the DOH. The DOH is assigned to a specific bureau
and several centers to ensure the program is well implemented. The Bureau of Local Health Systems andDevelopment manages the UHSD Program at thenational level, while the centers assist in its implementation in provinces and highly urbanized cities (HUCs)
like the Metro Manila Center for Health Development.
At the local level, the Marikina City Health Office is the
one responsible for ensuring the consistency of the local
Urban Health System (UHS) with the national policy on
UHSD (Figure 5). Similar to those in Indonesia, othercity agencies are also assigned responsibilities for various Healthy City projects, which are included in the city
plans and sectoral development plans and programs.
At the local level, both cities operationalize theirhealth programs through the city or sectoral development programs in collaboration with collaborating
national and international private sectors or organizations. For example, Marikina signed an agreement with
Clean Air Asia, an international non-governmentalorganization, on Integrated Program for Better Air
Quality in Asia as one of its ways toward developmentof the Marikina Clean Air Action Plan. This indicatesthat Indonesia and the Philippines created engagementswith every stakeholder from the government sector, citizens, the private sector, and national and internationalorganizations to participate in their Healthy Cities
program.
Participatory Planning and Budgeting
Community participation is an essential part of theprocess of good local governance, and empowerment
remains at the heart of effective health promotion.
Municipal governments must work closely with people
as an entry point to reach and engage them as part of thesolution (Lee & Nakamura, 2021). As mentioned before,
community participation is the core principle underpinning the Healthy City movement.
The practice of participatory planning in Yogyakarta
has been realized through the Healthy City Forum(FKS), and Resilient Family Technical Working Group.
The FKS forum played a crucial role in accommodating
community participation and empowerment. It also
facilitated discussions and dialogues to gather community ideas, inputs, and considerations related to priority

197

Indah Cahyaning Sari, et al.

agendas on Healthy City. To complement this,Yogyakarta Mayor Regulation Number 3 Year 2016
about Resilient Urban Village was enacted to ensurethat community commitment and participation arechanneled in micro-scale work area, including integrated public health development, as well as healthysociety development.
The efforts of building a healthy community should
involve its citizens, even though the programs emanatedfrom the government. The “whole-of-society” approachis about engaging the national and local governments,
academe, business, and private sector in Healthy City
programs and giving them with some degree of influence to perform certain responsibilities. One avenue isthrough community associations. Unlike Yogyakarta,
there are no specific forum concerning Healthy City
implementation in Marikina. The Marikina City
Government encourages and urges their citizens to be
involve in all Healthy City activities. Some of the
Healthy City programs and activities in both cities arelisted in the table below.
Table 4. Healthy City Programs and Activities
Yogyakarta
WasteManagement(Jaripolah)
Green Village
ProgramKampung
TangguhNusantara
healthy family
programWellness
Destination

Marikina
Marikina Healthy City Center.
Marikina Health Zone
Healthy Market / Clean Food Laboratory
Nutrition Center
Walkable sidewalks
Healthy public market with zerosidewalk vendors
Bicycle Friendly City
Disciplines on the Sidewalk
Debris - free waterways
Marikina River Park
Animal Quarantine
Free Health Care
Efficient Solid Waste Management
Senior Citizens Healthy Lifestyle Center
Diagnostic and Specialty Center

Source: Indonesia and The Philippines Government’s Website

Sufficient budget is needed for Healthy City projects
to be successful. Considering that Healthy City is a
public policy, one of the key requirements in order for it
to succeed is to secure sufficient budgets (Park, 2021).
Regarding this matter, Yogyakarta and Marikina have198

not allocated special budgets for their Healthy City programs/projects. The budgets are integrated with anyother health projects. Based on the Budget Revenue andExpenditure of Yogyakarta City in 2022, IDR
374,702,254,362 out of IDR 1,794,427,166,854 (20.88%
of the yearly budget) was allocated to the health sector.
In 2020, Marikina appropriated PHP 144,384,757.04 outof PHP 4,652,582,452.39 (3.10% of the yearly budget)
for Health, Nutrition, and Population Control.
Urban Facilities and Infrastructure
For healthy urban planning, data are needed that are
not only linked to socio-demographic and environmental
factors related to the health of its population but the quality of urban structures as well (Sutcliffe et al., 2015).
Mapping urban structure with health data is a helpful tool
to identify characteristics at multiple levels, which will beessential for the formulation of evidence-based healthstrategies and for urban planning (Sutcliffe et al., 2015).
Health service is a fundamental factor of urban
health because accessibility of health services is a key
issue for health provision (Luo et al., 2022). According
to the Yogyakarta City Health Agency, in 2021, a total of
133 health facilities were available in over 14 sub-districts comprising of 15 hospitals (12 general hospitals
and 3 specialized hospitals), 4 maternity hospitals, 28
units polyclinics, 15 public health centers, 8 subsidiaries
of public health centers, and 43 pharmacies. The numberof beds available was 1,584 from the combined 15
hospitals.
Marikina has 85 health facilities with 621 total
number of beds (National Health Facility Registry v2.0
- Department of Health Republic of the Philippines).
These health facilities include 1 hospital (300-bed
capacity), 1 city-managed health building with clinicallaboratory, drug testing center, sputum microscopy,social hygiene clinic (HIV testing and care services),
birthing homes, dialysis clinics, drug abuse treatment
and rehabilitation centers, general clinic laboratories,
infirmaries, psychiatric care facilities, rural health units,social hygiene clinics, and COVID-19 testing laboratories. Apart from health facilities, other infrastructure
related to urban health are: access to water supply, solid6th AFC Best Papers (2022)

waste management service, and electricity supply. The
households in both cities are already supplied by cleanwater and household wastes collection service.
Urban Environment
The WHO stated that environmental factors and lifestyle are major determinants that affect human health,accounting for 17% and 60%, respectively (Li et al.,2020). More green spaces close to where people live andbetter accessibility to green areas have been shown to be
useful for improving human health and for tackling
health inequalities (Rostang, 2021). According to theIndonesian Government Regulation Number 6 of 2007,
a city should have at least 30% of their total land area
reserved for green open space composed of 20% publicgreen open space, and 10% green open space.
Table 5. Urban Environment of Yogyakarta and Marikina
Determinants
Yogyakarta
Green Coverage of Urban Built-up Area
Green space areas
263.63 Ha1Urban Walkability
Kilometers of bicycle paths
and lanes per 100,000
41.2 km
population
Air Quality
Concentration of NO2
6 μg/Ncm
μg/m3

Marikina
39.53 Ha
82 km
20.80
μg/Ncm2

Source: 1 Regional Development Planning of Yogyakarta City
2 The Philippine Realtime Ambient Air Quality Monitoring

The Yogyakarta Central Bureau of Statistic reported
that significant land use change have occurred in thecity. This is mainly attributed to conversion of agricultural lands to built-up areas approximately around
17.5%-27% in a span of 25 years. Yogyakarta City, withtotal land area of 3,250 Ha, has 263.63 Ha of green open
space (Bappeda Kota Yogyakarta, 2021), which only
covers 8% of the total land area. Compared to those in
Yogyakarta, Marikina, with the total land area of 2,150
Ha only has 39.53 Ha of green open space (Governmentof Marikina City, n.d.), which only covers 1.83% of thetotal land area of the city.
Crowned as a bicycle-friendly cities, both Yogyakarta
and Marikina have designated bicycle paths and lanes tosupport the safety of their cyclists. However, it is notedthat less than 10% of cyclists use their bicycles as ameans of transportation for work, except for people in
the informal sector. Yogyakarta also has the total of 41.2
km long bicycle path to support its tourism. However,compared to Marikina, the length of the bicycle lane in
Yogyakarta is only a half of the total length in Marikina
City, which in 2015, had 82 km long of bicycle lane. In
terms of air quality standards in Indonesia, the concentration of NO2 must not exceed 100 µg/m3. As for the air
quality in Yogyakarta and Marikina, both performed
poorly with concentrations of NO2 6μg/m3 and 20.80
μg/m3, respectively, which fall below the NO2 pollution
standard.

Fig. 6. Yogyakarta City Green Open Spaces Areas (Left) and Marikina City Green Open Spaces Areas (Right)
Source: Indonesia Geospatial Portal & Database of Global Administrative Areas (GADM)

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Indah Cahyaning Sari, et al.

Healthy City Approach as Assessment Tools in
Building Resilient Management
The assessment of Healthy City capacity in thisresearch was carried out with six determinants comprisedof 11 components and 15 indicators derived from a comparative framework sourced from the UHI that was published by the WHO in 2018. The indicators were chosen
based on data availability in both cities. The scoring ofeach component could be seen in Table 6 below.
As a result, Yogyakarta and Marikina demonstrate
similarities in the governance and organizational aspects
as well as policies and regulations. Achieving the ideal
Healthy City concept demands explicit political commitment, leadership, organizational and institutional
capacity, intersectoral partnerships, involvement of thelocal population in the decision-making process, andcommunity development (Alves, 2019). Both cities arewell maintained in terms of management, and have various Healthy City initiatives or programs, which involvecommunities. These programs could be used as models
for other cities to emulate Healthy City implementation.
However, there are also a lot of aspects that still need to
be improved and further developed, whether in
Yogyakarta or Marikina. On a positive note, most of
their indicators performed better compared to theirnational average values. Technically, cities, and urban
environment, are critical moderators of the interplay
between human health and sustainability (Siri, 2016).
The current moment of urban transformation due topandemic offers a unique opportunity to consider how
to live healthier lives on a healthier planet.

Table 6. Healthy City Capacity Assessment in Yogyakarta and Marikina
Determinants

Indicator

DemographicandGeographic

Geographic▪

Demographic(Health Status)

Policies andRegulation

Adopted policies toimprove urban
healthMultisector
engagement andorganizational
structure▪
▪
▪
▪

GovernanceandOrganizational
Structure
Participatory
Planning andBudgeting

HealthFacilities andInfrastructure
Urban
Environment

200

Components▪
▪

Program andactivities
addressing urban
health challenges
Community
involvement
Funding for
Healthy City
implementation
Health services andinfrastructure▪

Green Coverage of
Urban Built-up
Area
Urban Walkability▪

Air Quality

▪

▪
▪
▪
▪

▪

Population density (population per
km2)
Infant mortality rate
Maternal mortality ratio
Morbidity rate (by type of disease)
The availability of policies toimprove urban health in All Level
The availability of specificinstitution in charge for Healthy
City program and activities
Stakeholders’ involvements in
Healthy City program
The city-wide activities or specificprogram or activities derived frompolicy or initiated by the regional
autonomyCommunity initiatives or activities
related to Healthy City program
Indicative ceiling for healthaccording to Regional Revenues
and Expenditures Budget
Total number of hospitals or other
health facilities
Total number of beds in healthfacilities
Hectares of green spaces area per
100,000 population (Green Space
per capita)
Kilometers of bicycle paths andlanes per 100,000 population
Concentration of NO2 μg/m3

Scoring Value
Yogyakarta Marikina
3
2
3
3
2
3

3
2
1
2

3

3

3

3

2

3

3

2

2

1

3

2

3

2

2

1

2

3

2

1

Indicator Source
WHO (2018),
Lee & Nakamura(2021), Palutturi etal. (2015), Tingting
Li (2020)
WHO (2018),
Palutturi et al., 2015
Pineo et al., 2019
Palutturi et al., 2015
Stevens et al., 2020

Palutturi et al. (2015)
Lee & Nakamura(2021)WHO (2018),
Tingting Li (2020),
Hanzl & Bezerra(2019)WHO (2018),
Yue et al. (2016),
Lee & Nakamura(2021),
Lowe et al. (2019)

6th AFC Best Papers (2022)

Fig. 7. Healthy City Capacity Assessment in Yogyakarta
and Marikina

Resilient Management in the Aftermath of thePandemic
The complexity of urban health poses enormous
challenges which the cities in this study were able toovercome even in the midst of the unprecedented publichealth emergency, i.e., the COVID-19 pandemic. The
degree to which urban system functions to deliver services for human health and well-being depends on thehuman capability to manage complexity and create
healthy urban environments (Elmqvist, et al., 2019).
Resilience management must be based on a deep understanding of the complexity of urban systems and thefunctions that they provide. Healthy City capacity mapping could be used as a first step in understanding thecomplexities of urban areas. Furthermore, managing
resilience in urban systems requires adaptive and flexible governance styles on several scales in order toenhance the multi-functionality of systems and functions that support Healthy City implementation.

Conclusion

Complex urban systems are not only multi-dimensional, but also multi-sectoral. Healthy City capacity
mapping is one of the tools to assess the complexity of
the urban system through the lens of health perspective.
As Yogyakarta and Marikina were awarded the healthiest cities in their respective countries, both cities could

be used as models for others in regard to their innovations, initiatives, and programs for Healthy City implementation, even though the results show that some
aspects still need to be improved. Urban green areas andthe greening of other types of infrastructure need to beplanned and managed to respond to the increasing healthrisks in these cities. To sum up, various programs on
health helped Yogyakarta and Marikina save their communities from the COVID-19 pandemic by providing
adequate health infrastructure. This is proven by thepercentage coverage of affected people that recoveredfrom the COVID-19 sickness. Furthermore, resiliencemanagement for urban health needs to respond to someinherent features of complex urban systems. As part ofresilient management, Healthy City could be one of themilestones that could tackle the challenges of complex
urban systems.
Notes: ‘Healthy City’ is used when referring to the approach or concept, meanwhile ‘healthy city’ referring to the city that has attained
the vision of healthful living for its residents.

Acknowledgements

The authors wish to acknowledge and thank to Prof.
Ebinezer Florano and Ms. Rose Gay Castaneda from
National College of Public Administration and
Governance, University of the Philippines for theirvaluable input and feedback on early versions of thismanuscript.

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